Food insecurity and the risk of diabetes: understanding the role of BMI as a mediator and moderator
Authors' conclusion
Our findings support BMI as a mediator and moderator of the association between food insecurity and diabetes.
Study context
- Population
- Primary care patients at a large academic medical center (electronic health records)
- Participants
- 74,174 patients
- Exposure
- Food insecurity vs no food insecurity
- Outcome
- New diabetes diagnosis; BMI as mediator and moderator of the association between food insecurity and diabetes
- Follow-up
- 5-year period
Methodological detailscausal mediation analysis, multivariate Poisson regression
- Causal mediation analysis
- Multivariate Poisson regression
Main finding
As reported in the abstract
Newly diagnosed with diabetes (all patients)
6.2%
Food insecurity and higher risk of diabetes, after multivariate adjustment: RR
1.19
95% CI 1.03–1.36
BMI as mediator, natural indirect effect: RR
1.10
95% CI 1.06–1.14
BMI as mediator accounting for interaction with BMI, natural indirect effect: RR
1.12
95% CI 1.0–1.17
Observational data: associations, not effects.
Further findings
Mediator-moderator effect of BMI by subgroup (age, sex, race and ethnicity)
- Stronger among adults <45 years old and female patients; no differences by race or ethnicity
Original publication
Food insecurity and the risk of diabetes: understanding the role of BMI as a mediator and moderator. Obesity (Silver Spring). Published 17 June 2025. doi:10.
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